Position Applied For: Ref No.

(including postcode)


Private Telephone No. Business E-mail address 2.
(from age 11) and further education


Dates From To

Examinations taken/results


Additional Qualifications and Work Related Training


PREVIOUS EMPLOYMENT Present/Last employer Name and address




.Job Title Responsibilities Reason for Leaving Notice required Present/Leaving pay Previous Employer Name and address £ From To Job Title Responsibilities Reason for leaving Previous Employer Name and address From To Job Title Responsibilities Reason for leaving Previous Employer Name and address Previous Employer Name and address Previous Employer Name and address From To 5. PLEASE EXPAND ON AREAS OF YOUR TRAINING AND/OR EXPERIENCE CONSIDERED SIGNIFICANT TO THIS APPLICATION.

ADDITIONAL INFORMATION Do you own a car? Do you have a valid driving licence? Do you have a LGV licence? Do you have any penalties on your licence? YES/NO YES/NO YES/NO Licence No: Expiry Date: YES/NO (If yes please give details) PROVISIONAL/FULL 8. Have you previously applied to us for any other position? Do you have any unspent YES/NO (If yes please give details) YES/NO (If yes please give brief details) .6. INTERESTS/HOBBIES 7.

This information will be separated from your application and will not be passed on to anyone involved in short-listing for this appointment. Signed______________________________ Dated_____________________________ REFERENCES (one should be your current or most recent employer) Please tick if you do not wish your referees to be contacted prior to job offer  Name: Address: Name: Address: Occupation Tel. you are required to complete this form and return it with your application form. Interviewer/s______________________________________ EQUAL OPPORTUNITIES MONITORING FORM THE FOLLOWING INFORMATION WILL NOT BE USED FOR SELECTION PURPOSES AND ALL APPLICATIONS WILL BE CONSIDERED REGARDLESS OF AGE. SEX. I HEREBY DECLARE THE FOREGOING TO BE ACCURATE TO THE BEST OF 9. To enable us to monitor the effectiveness of our Equal Opportunities Policy.No. Name: Position Applied for: Department / Site / Depot: Age: National Insurance Number: Male / Female Ethnic Group: (Listed as recommended by the Commission for Racial Equality) Please tick a box from the following list which best describes the ethnic category to which you belong.No.convictions? Time lost from work due Please give approximate number of days to sickness during last three years. FOR OFFICE USE ONLY Date_____________________________ Comments: Occupation Tel. MY KNOWLEDGE AND BELIEF (which I understand will be treated in the strictest confidence and in accordance with the Data Protection Act 1998). RACE. RELIGION OR DISABILITY. White British White Irish White Other Black African Please Specify: .

and you have one. Eligibility to Work Do you require a Work Permit to work in the UK? If yes. please give details below. If yes. If you fulfil the minimum criteria for the post you will be short-listed and we will explore jointly with you if there are ways in which the job can be changed to enable you to meet the requirements. please state Number and Expiry date: If you are offered this post. you will be asked to provide documentary evidence of your entitlement to work in the UK (in accordance with the Asylum and Immigration Act 1996) YES / NO Where did you hear of the vacancy? Local Newspaper National Newspaper Internet Internal Noticeboard Word of Mouth Other (please specify): Job Centre Specialist Publication Data Protection Act Under the terms of the Data Protection Act 1998 the information provided on this form will be held in confidence and used for the purpose of Recruitment and Selection and Personnel Administration and no other purposes. For further information please contact Human Resources Dept Viridor Waste Management Ltd . please list any requirements you may have if invited for interview: It is the Company’s policy to consider applicants entirely on their merits and successful candidates may be assured that appropriate efforts will be made to overcome any barriers which a health condition / disability may subsequently pose. Thank you for completing this form.Black Caribbean Black British Black Other Indian Pakistani Bangladeshi Chinese Other Please Specify: Please Specify: Disability Discrimination Act (DDA) 1995: Do you consider you have a disability? YES / NO If you have a disability according to the DDA.

I understand that any false statements on this form can render me liable to dismissal without notice. Signed: Dated: . to the best of my knowledge. the information contained on this form is true and correct. If I am successful in obtaining this post and the information is later discovered to be incorrect.Great Western House Station Approach Taunton Somerset TA1 1QW Tel: 01823 721423 Fax: 01823 721 489 DECLARATION: I hereby declare that.

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